Bill C-7 (Historical)

An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Alleged Premature Disclosure of Contents of Bill C-7

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I rise today on a question of privilege concerning the disclosure of Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced in the previous session.

In the interest of time, my hon. colleague, the member for Fundy Royal, raised this question of privilege on February 25. I would direct you to the arguments presented at pages 1518 and 1519 of the Debates.

Mr. Speaker, on March 10, you concluded that there was a prima facie breach of privilege, and the House adopted the member's motion to refer the matter to the Standing Committee on Procedure and House Affairs.

On March 12, the committee agreed to suggest dates for inviting the Clerk and the law clerk to appear so that it could begin studying the matter. The next day, the House adjourned because of the pandemic. This meant that the committee never had a chance to get back to its order of reference because of the various Liberal motions prohibiting virtual meetings on this subject. The Prime Minister then decided to shut down Parliament, ending the study before it had even started.

I am asking you to find another prima facie breach of privilege so that the House can once again examine the issue and, if it so desires, send it to the Standing Committee on Procedure and House Affairs. There are previous rulings in which a prima facie breach of privilege was found when prorogation put an end to an order of reference on a question of privilege before a committee was able to report to the House on it. More specifically, I would refer you to the ruling made by Mr. Speaker Milliken on February 6, 2004, at page 243 of the Debates of the House of Commons, when he said that, for the same reasons that he gave in a ruling he made in the previous session, the question remained a prima facie breach of privilege. He then gave the member leave to move his motion.

Another of your predecessors, the hon. member for Regina—Qu'Appelle, who we know well, also made a similar ruling on October 17, 2013, at page 66 of the Debates of the House of Commons. The same circumstances exist as in previous cases and it is appropriate to raise a prima facie question of privilege.

If you agree, Mr. Speaker, I am prepared to move the appropriate motion.

Physician-Assisted Dying

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, the second petition speaks to the government's priorities with respect to health care in January and February when it could have been focusing on improving seniors care and preparing for a response to the pandemic. The government's focus was instead on removing vital safeguards associated with the government's euthanasia regime. The petitioners raise concern about the government's plans previously in Bill C-7 to eliminate a 10-day reflection period and also reduce the number of witnesses required. The petitioners believe that these were important safeguards that need to be in place and question the government's priorities with respect to removing safeguards when there are so many other vital health care issues that we should be focused on.

Business of the House

[Pablo Rodriguez, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I thank my colleague for the question.

This afternoon we will continue debate on the NDP motion.

Tomorrow, we will resume debate on Bill C-4 on the free trade agreement with Mexico and the United States. We hope to conclude the debate that afternoon.

When hon. colleagues return from the constituency week, we will follow up with Bill C-7 on medical assistance in dying, Bill C-8 on conversion therapy and Bill C-3 on CBSA oversight.

Finally, I would like to inform the House that Monday, March 23, and Thursday, March 26, shall be allotted days.

Reference to Standing Committee on Procedure and House Affairs

[Rob Moore, Conservative, Fundy Royal, NB]

moved:

That the matter of the premature disclosure of the contents of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) be referred to the Standing Committee on Procedure and House Affairs.

Mr. Speaker, thank you for your finding that a breach of our privileges did exist in this case in the leaking of the contents of Bill C-7 to the media before members of the House could see the bill.

There is a reason we have rules in this place to protect the rights and the privileges of members of Parliament in this place on all sides of the House, so that we are able to do the job that we were elected to do, which is to represent our constituents, to pass legislation and to debate. Those are the things that we have been given the ability to do by our constituents. When we have government departments, government members that do not abide by the rules of the House, it undermines not just those members in the opposition; it undermines all of us.

It is well-established practice in the House that when a bill is on notice for introduction, the House has the first right to the contents of the bill. Everyone in the House knows this. We know that the House is paramount when it comes to the introduction of the legislation, but if there is any one department in the whole of government that we would expect would know the rules around the laws and procedures in the House, that department would be the justice department, the department tasked with making laws that impact the lives of all Canadians. That department knows better. That is a department filled with hundreds if not thousands of lawyers and legal minds that know better.

Let us say they did not know better. Just like with any one of our children, sometimes if they make a mistake, we correct them. Maybe if they make a second mistake, we will correct them again. By the third time around, we expect that they know the rules.

This is the fourth time there has been found a breach of our privileges in the House that was made by the Department of Justice. In fact, the last ruling on this matter was also on the previous legislation around medical assistance in dying. It was even the same legislation.

The article that was put forward within The Canadian Press had very detailed and specific information contained in the bill. That is why this breach of privilege has been found.

The reporters and those who were leaking know that contempt has occurred by revealing later in the article that, "The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon."

There is no doubt in anyone's mind that those who were leaking this information from the Department of Justice or some other arm of government knew exactly what they were doing when they did it. What they thought about this place is not much, because we have rules, and they thumbed their nose at the rules that we have.

After the sources indicated to the reporter that they were aware of their guilty actions, they boldly and defiantly continued their affront to Parliament by providing even more detail of the bill. Quoting again from that article, “Sources say today's bill will not deal with broader issues that were excluded in the new law and that must be considered as part of a parliamentary review of the law that is to begin this summer.” Again, bang on with what was in the bill.

We saw the news articles and we thought we knew what had happened, another leak from the Department of Justice, another affront to this Parliament, another breach of all of our collective privileges, but again we had to read the bill to find out whether in fact that was the case.

We carefully reviewed the contents of Bill C-7 following its introduction in the House. When I and other members of Parliament got to see the bill for the first time, others in the media had seen the bill in its entirety for hours before.

The details reported by The Canadian Press hours earlier were indeed contained in Bill C-7. Ironically, over and over, the first precedent that I had quoted earlier was from the last Parliament, brought to the Speaker's attention on April 14, 2016, and in regard to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

The department in question is being absolutely recidivist. It is not taking seriously the consequences and the rulings of Speakers. The Speaker in 2016 found that there was, in fact, a prima facie case of privilege regarding Bill C-14 and said:

As honourable members know, one of my most important responsibilities as Speaker is to safeguard the rights and privileges of members, individually and collectively. Central to the matter before us today is the fact that, due to its pre-eminent role in the legislative process, the House cannot allow precise legislative information to be distributed to others before it has been made accessible to all members. Previous Speakers have regularly upheld not only this fundamental right, but also expectation, of the House.

The Speaker's concluding remarks in 2016 were as follows:

In this instance, the chair must conclude that the House's right of first access to legislative information was not respected. The chair appreciates the chief government whip's assertion that no one in the government was authorized to publicly release the specific details of the bill before its introduction. Still, it did happen, and these kinds of incidents cause grave concern among hon. members. I believe it is a good reason why extra care should be taken to ensure that matters that ought properly to be brought to the House first do not in any way get out in the public domain prematurely.

On October 4, 2010, on page 4711 of the House of Commons Debates, Speaker Milliken noted:

It is indisputable that it is a well-established practice and accepted convention that this House has the right of first access to the text of bills that it will consider.

This all goes back to my point about the Department of Justice not taking seriously the rules of this House. The one department that ought to know best about the rules of this House is now a four-time offender, with breaches of privileges found by successive Speakers over the last several years, sometimes over the same bill subject matters. The House, and the rules of the House, are being completely ignored.

The Speaker found another case of contempt on October 15, 2001, after, and members are not going to believe this, the Department of Justice briefed the media on the contents of a bill prior to the legislation being introduced in the House.

Maybe, in this minority House, members can finally take this department and this Minister of Justice's office to account and to task for their continuous disrespect of the privileges and the rights of this place, and the rights of all Canadians who send us as members of Parliament to do good work on their behalf.

Alleged Premature Disclosure of Two Bills—Speaker's Ruling

[The Speaker, Anthony Rota]

I am ready to rule on the questions of privilege raised on February 25 by the member for Fundy Royal and on February 27 by the Parliamentary Secretary to the Leader of the Government in the House of Commons concerning the premature disclosure of two bills.

Allow me first to recapitulate the arguments presented by the two members.

On February 25, 2020, the member for Fundy Royal raised a question of privilege regarding a Canadian Press article published online on February 24 that detailed specific information contained in Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying, even before it was introduced in the House by the Minister of Justice. The member quoted from the article in question, which mentioned that anonymous sources allegedly discussed the contents of the bill with the journalist while knowing full well that doing so contravened the practices of the House. The member for Fundy Royal feels that this premature disclosure of the bill constitutes a breach of his privileges and contempt of the House.

On February 27, the Parliamentary Secretary to the Leader of the Government in the House of Commons raised a question of privilege also concerning the premature disclosure of a bill.

During this intervention, the parliamentary secretary said that a bill entitled “an act to amend the Criminal Code (unlawfully imported firearms)”, put on notice on February 21 by the member for Markham—Unionville, was also the subject of an article published on February 24 in iPolitics before it was introduced in the House. On February 25, the member put another bill on notice, one with a slightly different title, “an act to amend the Criminal Code (possession of unlawfully imported firearms)”. The bill became Bill C-238 after it was introduced on February 27.

The parliamentary secretary feels that the provisions of Bill C-238 correspond to what was described in the iPolitics article, and he presumed, therefore, that the two bills are in large measure the same. The parliamentary secretary suggested that this disclosure contravenes the principle that members are the first to know the contents of a bill. Since a breach of privilege was apparently committed, he suggested referring the matter to the Standing Committee on Procedure and House Affairs.

On February 28, the member for Markham—Unionville apologized and admitted that he had indeed discussed the contents of the first bill with fellow members and journalists. He said that he had acted in ignorance of the rule prohibiting discussion of bills on notice before they are introduced in the House. He also explained the reasons for the change in title between the two bills.

The same day, the parliamentary secretary to the leader of the government in the House presented his most sincere apologies for the premature disclosure of Bill C-7, saying in passing that no one within the government had been authorized to discuss the bill before its introduction in the House.

I believe that the whole matter can be summarized as follows.

First, based on a reading of the Canadian Press article on Bill C-7 on medical assistance in dying, and in the absence of any explanation to the contrary, I must conclude that the anonymous sources mentioned were well aware of our customs and practices and chose to ignore them. It seems clear to me that the content of the bill was disclosed prematurely while it was on notice and before it was introduced in the House.

Second, in his apology, the member for Markham—Unionville made it clear that his two bills on firearms were substantially the same, apart from the slightly different titles. It seems clear to the Chair, therefore, that the member also discussed a bill before its introduction. It matters little that the bill in question was subsequently withdrawn and never introduced in the House.

The rule on the confidentiality of bills on notice exists to ensure that members, in their role as legislators, are the first to know their content when they are introduced. Although it is completely legitimate to carry out consultations when developing a bill or to announce one’s intention to introduce a bill by referring to its public title available on the Notice Paper and Order Paper, it is forbidden to reveal specific measures contained in a bill at the time it is put on notice.

In this case, it is clear that the content of the bills, both the private member's bill and the government bill, were revealed to the media before their introduction and first reading. The question now is to determine whether the disclosure of these bills was a breach of the House’s privilege and whether mitigating circumstances should be considered.

In this instance, I am prepared to give the benefit of the doubt to the member for Markham—Unionville when he says that he was unaware of the rules regarding the confidentiality of bills on notice. I believe that his remarks were sincere and that he believed he was advancing his cause in a legitimate fashion.

My analysis is different for the question of privilege raised by the member for Fundy Royal concerning government Bill C-7. Permit me to quote a part of the article at the heart of this matter:

The sources spoke on condition of anonymity because they were not authorized to reveal details of the bill prior to its tabling in the House of Commons this afternoon.

Everything indicates that the act was deliberate. It is difficult to posit a misunderstanding or ignorance of the rules in this case.

On April 19, 2016, my predecessor, faced with a similar situation regarding the premature disclosure of Bill C-14 on medical assistance in dying, found a prima facie case of privilege in a decision that can be located on pages 2442 and 2443 of the Debates.

In light of the information provided by the member for Fundy Royal, the precedents and the current practice in this matter, the Chair notes the existence of sufficient grounds to conclude that there was a prima facie breach of the privilege of the House and the members and their right to be the first to know the contents of Bill C-7.

Consequently, I now invite the member for Fundy Royal to move the appropriate motion.

Alleged Premature Disclosure of Private Member's Bill

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Madam Speaker, in light of an apology from the member for Markham—Unionville with respect to the premature disclosure of his bill, I too, would like to apologize unreservedly for the premature disclosure of the contents of Bill C-7, medical assistance in dying.

I would like to state categorically that no one from the government was authorized to speak publicly on this bill prior to its introduction.

Palliative Care

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, there is one thing I have learned since being elected, and that is that what the left says never means what people might think it means.

When Liberals talk about unity, what they really mean is “My way or the highway.” When they talk about diversity, they never mean diversity of opinion. When they talk about truth and reconciliation, they have no intention of respecting elected band councils unless it is convenient. When they talk about consultation, what they really mean is, “Let me tell you what I think.” When they say “dying with dignity”, they only mean euthanasia.

Canadians look to this House for compassion, truth and leadership. In light of this week's debate on Bill C-7, let us ensure that when we say we are committed to quality palliative care, we truly mean what we say we mean.

Opposition Motion—Additional Allotted Days

[John Nater, Conservative, Perth—Wellington, ON]

Madam Speaker, “Parliament is more than procedure – it is the custodian of the nation’s freedom.” Those words were spoken by the great defender of parliamentary democracy, the Right Hon. John George Diefenbaker.

Today, we find ourselves called upon to once again stand in support of this great institution, to once again stand for the right of opposition parliamentarians to hold the government to account.

Many Canadians may not be closely following the business of supply. They may not closely follow the allotted days, or the opposition days, that are often called in Parliament. However, these days, in which the agenda of the House falls to the opposition parties, are absolutely essential to our great parliamentary democracy. We as the opposition, both the official opposition and the other opposition parties, have the right to bring forward matters that we feel are important to our constituents and to all Canadians.

Beauchesne's Parliamentary Rules and Forms, sixth edition, states “The Opposition prerogative is very broad in the use of the allotted day and ought not to be interfered with except on the clearest and most certain procedural grounds.”

We have brought forward this opposition day motion on this day for very important reasons. The Liberal government decided to punish the official opposition by giving us a short parliamentary day, a short day when only two full speaking slots would be allocated to the opposition parties.

The Liberal government seems to have forgotten that it is among the weakest governing mandate in Canadian history. The Liberals forget that they actually lost the popular vote in the last election and Canadians saw fit to return them with a minority of seats in this place.

Bosc and Gagnon states the following, on page 855:

The setting aside of a specified number of sitting days on which the opposition chooses the subject of debate derives from the tradition which holds that Parliament does not grant supply until the opposition has had an opportunity to demonstrate why it should be refused.

In other words, before we as the opposition can consent to the continued funding of the government, we must, and we will, have the opportunity to raise our concerns in this place. We will not be silenced. We will not accept that the government, and only the government, has a legitimate voice in this place.

I would remind members of the Liberal Party that they are first and foremost members of the legislative branch of government. Those who do not sit in cabinet are not members of the executive branch. They are parliamentarians and parliamentarians first and foremost. They too should be concerned that the members of the executive branch of government are the ones who are trying to control the debate of this very place.

I ought not to need to remind the government of its legislative record and its mismanagement of House time in the previous Parliament. At the time of dissolution, it had left at least 17 government bills lying on the Order Paper. This is in spite of the fact that it used time allocation on dozens of occasions. On top of that, there were 13 motions for closure and 40 motions to proceed to orders of the day, thereby bypassing the opportunity for opposition MPs to move concurrence motions or to table petitions on behalf of the constituents in each of our 338 ridings across the country.

Today's debate is about returning the House to the people, to give the official opposition, the Bloc Québécois and the New Democratic Party each one additional opposition day during the supply period, to give each of these parties the opportunity to raise the issues before granting supply to the Liberal government.

I do not need to remind the House either about the disregard we have seen in the past by the Liberal Party to this institution.

In the previous Parliament, on one of its very first bills, Bill C-14, the medical assistance in dying act, the Liberal government was found to have contravened the rights and privileges of the House by leaking the contents to the media before it was tabled for all parliamentarians to see. Old habits die hard, because it appears it did that once again this time with Bill C-7, the amendments to medical assistance in dying.

The Conservatives do not need to remind the Liberals either about the impacts they bring upon themselves when they attempt to use draconian measures to shut down debate in the House. We all remember Motion No. 6, when they tried to unilaterally take control of every mechanism for debate in the House. We do not need to remind the Liberals of the standing order standoff, when they tried to diminish the opportunity for the opposition to hold the government to account by unilaterally changing the rules of the House. It fell to the Conservatives, as the official opposition, and the third party, the New Democrats, to ensure we were that line of defence, that we were that thin line of the wedge to prevent the Liberal government from doing that.

In fact, in the previous Parliament, during a debate in this very House on a question of privilege, one of the most significant matters with which the House can be seized, a Liberal member of Parliament, the member for Brossard—Saint-Lambert, stood in the House, used a procedural measure to move to orders of the day and killed that debate. However, our Parliament is stronger than any one Liberal member of Parliament. At that time, the Speaker saw fit to return that question of privilege to the House so members of Parliament could have their voices heard.

We see this time and again with the Liberal government. At every opportunity it has to do the right thing, it goes the opposite direction.

That brings me to the events we have seen just in the last couple of weeks on the new NAFTA. It is not a great deal and it is not the worst deal; it is somewhere in between. We are the party of free trade and we support the implementation of the new NAFTA despite its imperfections. However, to hear the Deputy Prime Minister state publicly and in this place that the Conservative Party was somehow trying to delay the new NAFTA is an insult to the opposition and to the House of Commons.

Just yesterday, my colleague, the opposition House leader, gave the Liberals the opportunity to right their wrong by bringing forward NAFTA today. We could be debating NAFTA today and I could be raising the concerns of the people of Perth—Wellington, the farmers, the manufacturers, individuals who have concerns with the bill. However, the Liberals did not budge. In fact, speaking for the government, the parliamentary secretary to the government House leader said no, that the government would not be willing to bring NAFTA forward. That is unacceptable.

We stand here today debating this opposition motion, a motion that gives the rights and responsibilities of the House back to all its members. I encourage all members to stand for their parliamentary privilege, to stand for democracy and vote in favour of this motion.

Criminal Code

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Madam Speaker, all of the speeches in the House come from a great place. On my side of the House we value life, and that is meritorious. We have heard other perspectives that talk about ending suffering and that truly has merit, so I appreciate all of the speeches that have taken place on such an important topic.

I know members have gone over this, but just for clarity I want to go over the background for medically assisted suicide in Canada. The 2015 Carter case was a landmark decision for the Supreme Court of Canada. The previous prohibition for assisted suicide was challenged as contrary to the Charter of Rights and Freedoms. In a unanimous decision, the court abolished the provision in the Criminal Code, thereby giving mentally competent Canadians who were suffering intolerably the right to medical assistance in dying when they had provided clear consent.

In June 2016, the first legislation on medical assistance in dying was passed in Canada's Parliament. In the recent 2019 Truchon decision, the Superior Court of Québec considered the constitutionality and Quebec's requirements in accessing MAID. The plaintiffs in the Truchon case were suffering from grave and incurable medical conditions that were causing tremendous suffering and a total loss of autonomy. However, they had each been refused MAID under the legislation in Quebec and federally. Because they were not at the end of life for the Quebec legislation and federally, death was not reasonably foreseeable.

Madam Justice Baudouin held that “reasonably foreseeable natural death” in the federal provisions infringed the plaintiff's fundamental rights under sections 7 and 15 of the charter. The court declared the impugned provisions unconstitutional. In a surprising and, in my mind, incorrect decision, the government chose not to challenge this decision, thereby getting guidance from higher courts such as the Supreme Court. By not challenging this legislation, the Liberal government was admitting that the legislation the House passed was deeply flawed.

The court's decision in Truchon gave the government until March 2020, which is now in the process of being extended, to amend the legislation to remove the reasonable foreseeability of death criteria from the MAID legislation. Prior to the introduction of this bill, the government conducted a narrow consultation process, limiting its consultations to urban centres and online surveys.

The minister noted several times, in his address to the House, that the provisions of Bill C-7 were the result of this process. However, he will not share that consultation with Parliament. This lack of respect is disheartening, and counterproductive to open and meaningful dialogue. I wish the government would stop playing games with such important topics and share the information it has with this minority Parliament.

Given that there is a limited timeline, that we are in a minority Parliament, and that MAID legislation will be subject to a complete review this summer, I would have expected the government to take a limited approach. Rather, the government has chosen to take a very different approach. The legislation makes substantial changes to the MAID eligibility far and beyond what is required to the Truchon decision.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, medical assistance in dying, or MAID, is complex. It is a deeply personal and difficult topic, yet this past January alone, more than 300,000 Canadians took part in the online public consultation to have their say. Many others, including experts and family members of loved ones who received MAID, took part in round-table discussions.

We also heard how the legislation is working from many of the conscientious health care providers involved in delivering this service. Canadians are engaged and aware of the importance of bringing the compassionate, sensible measures contained within Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

This bill builds on the foundation laid by the current legislation on MAID, passed by Parliament in June 2016, and extends eligibility for MAID to persons who, while suffering intolerably, may not be at the end of life. This bill respects the Truchon decision and supports the autonomy of Canadians wanting to make an informed choice to end the suffering they face as a result of serious illness, regardless of whether their condition is life-threatening in the near term.

Respecting the autonomy of Canadians while protecting the safety of vulnerable people remains our central objective. That is why Bill C-7 proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

We have proposed to ease certain safeguards that had the unintended consequence of creating a barrier for someone accessing MAID whose death is deemed reasonably foreseeable, and we will introduce new and modified safeguards for eligible persons whose death is not reasonably foreseeable.

Bill C-7 would permit the waiving of final consent for persons at the end of life who have been already assessed and approved to receive MAID, but who are at risk of losing their decision-making capacity before it can be provided. There was very strong support for this type of amendment from Canadians, experts, health care providers and their professional regulating bodies.

Our government recognizes the importance of data and science-based evidence in the decision-making process. That is why this bill proposes that we expand data collection through the federal monitoring regime to provide a more complete picture of MAID in Canada.

I would like to note that following the Truchon decision there has been widespread speculation about the potential for persons solely with mental illness to be eligible for MAID. However, many stakeholders in the mental health community have expressed deep concern about this possibility. They feel this option directly conflicts with important treatment principles, which are that there is always hope for recovery and that people can live fulfilling lives with a mental illness.

From the perspective of many health care providers and many health care specialists, assessing eligibility for such individuals poses numerous challenges. Mental illnesses are not generally considered to be incurable, which is a requirement under the current law. In addition, the trajectory of such conditions can be more difficult to predict.

In light of the multiple challenges we heard and the lack of support from the practitioner community who would bear the responsibility for conducting eligibility assessments, this bill does not permit MAID for persons whose sole medical condition is a mental illness.

This decision was not taken lightly. It in no way implies that suffering associated with mental illness is any less severe or more tolerable than that associated with another medical condition, such as one arising from a physical condition. Rather, this decision reflects the many uncertainties underlying this question and a concern that allowing MAID in these circumstances could place Canadians at risk.

We recognize that there are proponents who support MAID eligibility for persons solely with a mental illness. However, in light of the Quebec court decision and the compressed time frame for legislative amendments, there is insufficient time to fully address this topic and determine whether a regime that allows access to MAID for persons whose sole underlying condition is a mental illness is viable.

For these reasons, we are adopting an incremental and cautious approach. It is our view that this issue should be explored as part of the parliamentary review process, which is expected to begin later this year.

It is easy as parliamentarians and as legislators to lose the human element of what we do and to focus on talking points and politics, but these compassionate and sensible measures have come from extensive consultation with Canadians, experts and folks who have lived with the unintended consequences of the original legislation.

These are folks like the late Audrey Parker, a Nova Scotian who wanted to spend just one last Christmas with her family but ended her life through MAID two months prior, while she could still give consent.

I want to take this time to read some of Audrey Parker's final posts into the record so they will be preserved in Hansard, because this legislation includes her amendment. As my colleagues in the House debate, discuss and study the bill, I want them to remember that there are many folks like Audrey across Canada who deserve this autonomy and this compassion.

She said:

“This is my last note to you. I can tell you I loved my life so much and I have no regrets. I feel like I’m leaving as my best self and I’m ready to see what happens when I die today. I’m hoping for something exciting to happen but I guess I won’t know until the time is here.

“The one thing I’m happiest about, is that I finally found ‘my people’ during my lifetime. I’ve even met new people that I already adore near the end of my journey so it’s never too late for anything in life.

“In the spirit of teaching and sharing, I’d like to leave you with some words that explain my position with MAID.

“When the MP’s debated MAID federally, someone decided to add late stage consent as a fail-safe to ensure no one dies at the hand of another.

“There are four categories of MAID candidates.... Of the four categories, the only one that is cut and dried is my category of Assessed and Approved. We are terminal, suffering outrageous pain and there is no time frame with using MAID. The kicker that makes it difficult is the late stage consent.

“As I near my death today, it is even more evident than ever before, that late stage consent has got to be amended and removed from MAID in Canada for my category of end users.”

“Dying is a messy business. I can’t predict when cancer will move into my brain matter or when something else big happens to make me more unwell. I and only I can make that decision for myself. It’s about living out every extra day that I can. No one including my doctor knows what the right day to die will be. Only I can know that as I wake each day. I’m not going to wait until I lose myself.... I wanted to make it to Christmas and New Year’s Eve... my favorite time of the year but I lost that opportunity because of a poorly thought out federal law.

“Had late stage consent been abolished, I simply would have taken my life one day at a time. If I noticed I was losing capacity, I would have taken control myself....and called my doctor to come assist me with my death. All I have to give is 24 hours notice so she can pick up the drugs from the drug store in my neighborhood. We were totally organized but the law tied our hands.

“This decision has to come from the patient. No one else. That’s why we the dying should be living day to day until we have to leave by invoking MAID.

“Be happy everyone and be kind to others.... Audrey.”

I ask that all members in the House support Bill C-7.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her speech.

I would like to remind her that medical assistance in dying is an intervention allowed only in exceptional cases, under very strict conditions. Access to this intervention is strictly regulated by law.

Bill C-7 will not bring about an unreasonable increase in MAID cases. According to a report of Quebec's commission on end-of-life care, from December 10, 2015, to March 31, 2018, a total of 830 requests for MAID were denied for various reasons, including the death of the person before the procedure, the withdrawal of the request by the sick person or a death that was not reasonably expected.

In short, there is nothing in Bill C-7 that will cause a substantial increase in requests for medical assistance in dying.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I appreciate the opportunity to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced earlier this week and dramatically expands the existing euthanasia regime in Canada.

This bill was introduced in response to a ruling made September 11, 2019, where the Superior Court of Québec found, in Truchon versus the Attorney General of Canada, that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life.

I believe it is completely unacceptable that the government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians that the Liberal government put in place less than five years ago. Appealing this decision would have allowed us to get certainty on the framework within which Parliament can legislate.

The summary of the bill states that it amends the Criminal Code to:

among other things,

(a) repeal the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying...

It excludes mental health as an eligible reason to receive assisted suicide. It creates two sets of safeguards that must be respected before medical assistance in dying may be provided, which differ in application depending on whether death is reasonably foreseeable. It also creates an advance directive wherein a medical practitioner can proceed with assisted suicide without consent immediately before administering it, assuming all other criteria are met and the patient enters into an arrangement in writing with a medical practitioner or a nurse practitioner to cause death on a specified day.

While these changes are significant, it is the other things where I will focus most of my attention. In responding to Bill C-14 in the last Parliament and now to this bill, it has always been our priority, on this side of the House, to ensure that legislation permitting euthanasia and assisted suicide includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and allied health professionals.

Of all the proposed changes, I am most concerned about the removal of the 10-day waiting period. This was not a change mandated by Truchon. Rather, it is a deliberate choice by the Liberal government to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognoses.

Nearly every one of us can think of someone in their lives, perhaps a friend, a grandparent or even a spouse, who has received a serious diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown.

I am sure many of us can also think of people we know who have received terminal diagnoses and went on to beat their illness and live for years afterwards. However, with the safeguard of a 10-day waiting period gone, such stories may be fewer and farther between.

Without having to take the time to come to terms with their situation, to speak to their families and to learn about treatment options from their doctors, many people will make emotional decisions based on fear.

Another amendment removes the need for two independent witnesses and allows health care workers to act as witnesses. People may not even hear another voice offering a different solution.

By making these changes, we diminish the extremely important role legislators play in contemplating all of the unintended outcomes and consequences and then protecting against them. We know very well that the current euthanasia regime has serious problems, that it has been abused and that it has been used as a tool of desperation after the failures of government.

Sean Tagert suffered from an advanced case of ALS that left him completely paralyzed, unable to speak and reliant on a ventilator. Despite these challenges, Tagert fought to stay alive so he could watch his son, whom he spoke of in lengthy Facebook posts, grow up.

Sean required 24-hour in-home medical assistance to stay alive. Initially the health care system provided him only 15 hours, leaving Sean to somehow pay hundreds of dollars each day. Eventually, even that was too much for the health authority. Health care authorities told Sean that he would no longer receive funding for home care, leaving as his only option institutional care at a facility hours away, separated from family and removed from the son he called his reason for living.

Sean appealed, but to no avail. He was going to lose his home care. Mr. Tagert fought long and hard for the rights of persons with disabilities and their families but in the end, he was driven by his desperate circumstances to believe that assisted suicide was his only option. He was “worn out”, in his own words. On August 6, 2019, he ended his life.

I am going to read from the statement his family posted at that time:

We would ask, on Sean's behalf, that the government recognize the serious problems in its treatment of ALS patients and their families, and find real solutions for those already suffering unimaginably.

“Real solutions” does not mean removing the safeguards for those who are the most vulnerable. It means providing true alternatives, be that palliative care, in-home care or the unique care needed.

It is not enough to simply put in legislation as we find here in proposed paragraph 241.2(3.1)(g), under Safeguards:

...[to] ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or...care.

If we have no intention of ensuring that those services are being funded or are even available, we have failed.

I note that the current federal government broke a key election commitment to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. That point has been made over and over during this debate.

People should never be put in a position where they believe death is the only solution available to them. We are, and we must be, better than that. We must protect every human life with a jealousy born of the knowledge that each person is unique, and has an innate dignity that nothing, not time, not illness nor disability, can ever take away.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, it is an honour to speak today to Bill C-7 regarding medical assistance in dying. This is the second time, the first being in the last Parliament, that I have had the opportunity to take part in the debate on this absolutely essential legislation on such a difficult subject.

This bill represents a major improvement and reflects some of the amendments that I made but that failed in the House, in the 42nd Parliament. Some of those amendments, in fact, were picked up and approved by the Senate.

I want to stop and reflect on the trajectory of this issue in Canada.

As identified when I rose in my place, I am a member of Parliament for Saanich—Gulf Islands and I believe that Saanich—Gulf Islands may have more constituents concerned with and calling for medical assistance in dying than perhaps any other riding in Canada. There are two active death-with-dignity groups within my community, one on Salt Spring Island and one on the Saanich Peninsula, and I think it is for a very simple reason.

Feelings run high, and honestly, my constituents persuaded me in 2011 and 2012 that I had to stand up for ensuring that there was access to medical assistance in dying and stand up for removing the Criminal Code punishments for people who, motivated by compassion and basic human dignity, assisted someone who was dealing with unbearable suffering in their last days and weeks.

The reason that my community is so very implicated in this issue is that Sue Rodriguez was a resident of North Saanich. She was unable to take her own life due to the effects of ALS, but she was able to find a doctor, who remains anonymous to this day, who assisted her in ending her own life.

It is clear that many people in my riding support the measures in Bill C-7, as they did support Bill C-14 in the previous Parliament.

This is about helping to alleviate suffering through medical assistance in dying. This difficult and very serious situation is unfair to anyone.

Sue Rodriguez went to court, so it is also a trajectory of court cases. The Supreme Court of Canada ruled in 1993 against Sue Rodriguez. She was suffering from ALS. ALS runs as a thread through what I want to talk about today. Sue was losing ability and had lost ability to speak, to swallow and to walk. We know the trajectory of ALS. She asked the court to change the law and she was unsuccessful. That was in 1993. By the way, it was a very close decision. It was five to four, a very close decision. She died a year later, on February 12, 1994.

Then we take it to 22 years later. That is how slowly the laws evolve. It takes a while. The Supreme Court of Canada and the laws of Canada evolve to meet the changing circumstances. I think part of the reason is that we also realize now, unlike 20, 30, 40, 50 years ago, that we can prolong lives and sufferings through miracle advancements in medical science, but before we passed this law in the 42nd Parliament, we were denying people death with dignity and the ability to control their own decision-making about the timing of their own death.

Along came the Carter decision, finally, in 2015. Twenty-two years after the Supreme Court of Canada decision in Rodriguez, we had the decision in Carter. I felt very strongly when we debated the bill for medical assistance in dying in this place in the last Parliament, the 42nd Parliament, that our legislative efforts fell far short of what the Supreme Court of Canada ruled in Carter.

I felt quite sure, and said many times in this place, that the legislation we were passing, while an improvement, would not stand up to legal scrutiny and would be ruled unconstitutional by the courts. Now we have the decision that came out last September in the Truchon case, and again a court has given us a deadline to come up with an improvement. It is being called Audrey's amendment. Certainly a lot of people have identified with that situation, and their hearts have been broken by knowing that medical assistance in dying was out of the reach of people who were suffering gravely but feared they would not be able to form the required consent on the day of the procedure.

I think the bill before us is a substantial improvement, and it really reflects on how courts grapple with this issue and how society grapples with it.

I have to say that in the 42nd Parliament, I found the debate remarkably respectful. Across all parties, we recognized that these are serious matters of life and death, not to be trifled with and not to be turned into partisan debate. The reality is that in this legislation we do make amends for some mistakes in the previous bill.

I always find it rather odd that we have to find that a person's natural death is “reasonably foreseeable”. I do not think any of us in this place fancy ourselves immortal. All of our deaths are entirely foreseeable; we just do not know exactly the time and place in which they will occur.

Doctors of those who are suffering from a terminal illness are not even able to say the reasonably foreseeable date. What does it mean to be reasonably foreseeable? We put people in a stricture where even if they knew they had a terminal illness, such as ALS, they could not necessarily get aid from this legislation and they could not necessarily give advance consent to a doctor to indicate that they did not want to go through what they knew lay ahead of them.

One of my best friends emailed earlier today to ask me to stand up and fight this bill, because she is dying with ALS and she did not think the bill would cover her. I spoke to the Minister of Justice to confirm that I was reading the bill correctly and that, yes, they were thinking specifically of people with ALS.

Our friend who used to sit in that chair, Mauril Bélanger, was lost to us so quickly through ALS. My friend, who is losing the ability of speech, is in a chair and has tubes in her stomach that cause enormous pain. She knows that her lungs will give out, so she is emailing me while we are having this debate. I was really relieved to talk to the Minister of Justice and realize that I am reading the bill correctly, that my friend can get the help that is needed to be assessed and be able to say that she wants consent in advance.

However, I do think that there are some areas for amendments that should be made here, and I wish we had more time. I hope the court will give us the additional four months, but we do not know that.

Some of the bogeymen that have been raised here today I think are considered in the bill. We do have the requisite safeguards to keep vulnerable people safe. No one can give permission for medical assistance in dying other than the patients themselves. They still have to meet very tight criteria. They have to have a sworn witness. They have to have a doctor. The bill also provides that on the day of the procedure, if a person indicates that they have changed their mind, they are completely allowed and of course have the right to indicate that they have changed their mind through all sorts of gestures and words, but not through any involuntary gestures. I think the bill is drafted as well as it can be, but we will continue to consider it in the amendments at clause-by-clause consideration.

The bill does continue to ensure that the death is reasonably foreseeable, and there may be some complications there in the language. I note concerns from Dr. Jocelyn Downie at Dalhousie University, who is one of Canada's leading experts in this field, and I want to hear her evidence. I hope that she will be a witness, and I am sure she will be, as well as Dr. Stefanie Green, the president of the Canadian Association of MAID Assessors and Providers. We want to make sure we get the language right.

I will close by thanking the Minister of Justice and the government for following through and hearing the cries of Audrey, from Halifax, that her death be not in vain.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, during this debate time, we have an opportunity as legislators to ensure that we carefully and thoughtfully examine Bill C-7 with the best interests of Canadians in mind.

On September 11, 2019, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. Although the current bill before the House, Bill C-7, responds to the court's ruling, it goes far beyond the scope of Quebec's decision and it weakens the important safeguards that have been put in place under Bill C-14.

Since the Liberals put this legislation forward, I have heard from hundreds of my constituents in a matter of days. They have shared with me that they are very concerned about the bill.

I will use my time today to share a number of the concerns they have raised and to issue a thoughtful word of caution to this place.

First, there is a parliamentary review of the original legislation scheduled for June. The question has to be asked. Why are we rushing to expand the scope of the current legislation?

We are literally discussing life and death issues. Death, something so final, deserves just a little of our time, our attention and due diligence.

The government's original legislation went through a very lengthy consultation process. This time, however, the consultation only lasted a couple of weeks. That is not the sole concern I have. In addition to that, when I look at this survey, the questions that were asked were quite vague and the multiple choice answers that were provided were drafted in such a way that the party in power could interpret those answers to the secure findings it desired. It was unclear and therefore unhelpful, if we really are going to respect the voices of Canadians.

However, the fact that this survey was so unhelpful goes to show that the current government was not interested in hearing from Canadians. The current government was interested in pushing through its agenda and therefore being able to twist and manipulate the survey data to its end, which is absolutely wrong.

It is wrong, because it goes against the very essence of this place, which is 338 common people representing common people. This place exists for us to deliberate the issues that matter most in our country and to speak up on behalf of Canadians. Unfortunately, what we have before us is a bill that represents the Liberal agenda rather than the voices of the Canadian people. This is wrong.

With legislation of this magnitude, I would urge the members of the House to slow the process down, to consult extensively and for us to come back to the table.

I cannot think of another responsibility we carry as legislators that is more crucial, more obligatory than our duty to protect the most vulnerable in Canadian society. Therefore, we have to take every effort to alleviate any possibility for abuse or misuse based on what is in this bill or based on what is left out of the legislation.

My Conservative colleagues have raised many concerns and have given multiple examples where extreme liberties have been taken with physician-assisted suicide where there are looser restrictions in place. I do not wish to rehash all those examples here today, but I certainly will draw the House's attention to a few.

Sadly, members across the floor have disregarded many of those examples provided by my Conservative colleagues. They have suggested that the differing jurisdictions and rules should deem these cases irrelevant in this place.

We have the opportunity and even the duty to learn from other countries and the way they have legislated, to learn from cases within our own country and to make changes that are necessary to properly protect Canadians.

It is undeniable that as one's medical condition progresses, the individual inevitably become more vulnerable. It is our responsibility to stand up for the vulnerable.

Individuals could lose their ability to speak, to move autonomously or they could lack the coherent and cognitive ability to be able to interact correctly. When an individual reaches this state, this is precisely when the safeguards around MAID, medical assistance in dying, should be strong enough to keep them safe rather than weak enough to make them vulnerable.

The proposed change in the bill would allow for advance directive, which takes away the need for the patient to consent immediately before having medical assistance in dying administered. This proposed change is alarming and dangerous as well to the Canadian public.

When we are faced with difficult physical ailments, they often fluctuate in intensity and as they do, our decision-making ability shifts. Think for example about people who are suffering from terminal cancer. They have been advised by medical professionals that their quality of life is likely to deteriorate to a certain degree by a specific date. Let us say that does not happen. Those cancer patients who want to avoid unnecessary pain have already given the date on which their lives will be terminated.

Changes take place. What if the diagnosis the doctor gave was not right? What if those patients have actually fared much better? Health care professionals could in fact euthanize these individuals at any point without needing to obtain consent immediately before death is administered.

This should concern all of us because of the vulnerability that is in place here. There should be a requirement for contemporaneous consent. We cannot allow one's former self to dictate the will of his or her present self. Minds change, circumstances change, so final consent is an absolute necessity.

This example has been raised in the House at least once before, but it is worth raising again because it is close to home.

Taylor Hyatt is a staffer on the Hill. I had the opportunity to interact with her personally. She has a linguistics degree from Carleton University. She lives on her own and she loves her life. Taylor has cerebral palsy and is restricted to a wheelchair. She lives an incredible life and contributes to Canadian society in a multitude of ways.

Two years ago Taylor went to the hospital because she was feeling quite ill. The doctors did some tests and they said that whatever it was it really was affecting her breathing, and if it came to it, should they administer oxygen.

Taylor was quite surprised at the question. Of course she would want oxygen, that seems like a very basic thing. It is not like it was life support or something that people often take, those decisions of that magnitude, quite seriously. It was the simple administration of oxygen. A few seconds later, the doctor asked "Are you sure?", and he said it in such a way that he was actually applying pressure on her to reconsider her decision, as if to say that her life lacked the value that she felt it had.

That is atrocious. If we are sending that message to the most vulnerable in our society, then what have we become?

I would like to also address one other thing, and that is the need for palliative care. If we are going to talk about administering death to Canadians, then why are we not having a conversation around long-term care? If we are going to talk about the dignity of a human life, then what about those who want to live a dignified life right up until their last breath?

Why is the government not moving forward with the plan it promised to put in place with regard to palliative care? Why is it not spending the money that needs to be spent on preserving the dignity of those who wish to choose this type of death? These are essential questions with which the House must wrestle.

I would caution those within this place to take a step back, because we want our country to be one that supports all people.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Mr. Speaker, I am pleased to rise today in support of Bill C-7, which proposes amendments to the Criminal Code's medical assistance in dying regime, in response to the Superior Court of Québec's Truchon decision. I will provide the context for the change.

As we know, in September 2019, the Superior Court of Québec struck down the federal and Quebec criteria that limit the access to MAID based on circumstances where death is reasonably foreseeable. The court, whose ruling only applies in Quebec, suspended its declaration of invalidity for six months, until March 11, 2020. On February 17, the Attorney General of Canada filed a motion to request a four-month extension to give Parliament the time needed to implement a response and ensure that the law across the country is consistent as it relates to the federal MAID regime.

I will provide a brief overview of the amendments to the Criminal Code that are being proposed under Bill C-7.

First, on the eligibility criteria, the bill would repeal the reasonably foreseeable natural death criteria and exclude persons whose sole underlying medical condition is a mental illness. Second, with regard to safeguards, the bill would create two sets of safeguards, depending on whether a person's death is reasonably foreseeable, while easing some existing safeguards and adding new ones for persons whose death is not reasonably foreseeable. Finally, the bill proposes to allow for a waiver of final consent on the day of the procedure in specific circumstances.

How did these changes materialize? The development of this legislation was informed by the Truchon decision; available Canadian and international reports, such as the December 2018 report of the Council of Canadian Academies; the experience of existing international regimes; and our government's recent consultation on MAID, held in January and early February.

The Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, along with their parliamentary secretaries, hosted several federal MAID round tables across the country. These events were attended by experts and stakeholders, including doctors, nurse practitioners, representatives from health regulatory bodies, legal experts, representatives of the disability community, indigenous representatives and other key stakeholders. They shared their experience and insight into MAID and its implementation in Canada over the last four years.

In parallel to these efforts, our government heard from over 300,000 Canadians who participated in the online public survey on MAID between January 23 and 27, 2020. There was an unprecedented number of respondents, reflecting the significance of this issue for Canadians. This kind of input is invaluable to government and, I am certain, was seriously considered by the ministers in the development of the bill.

I would like to provide a personal perspective on the issue of MAID in its previous iteration.

In 2015, when the Liberal government came to power, it was tasked by the Supreme Court to amend MAID. A special joint committee was established, involving both Houses and all parties. The special joint committee conducted an enormous amount of consultation and came up with a proposal. The then minister of justice and minister of health were presented with this proposal. Through intense discussions and consultations, the proposal was amended.

In my riding of Don Valley East, I did a consultation in the sanctuary of the Donway Covenant United Church. Various constituents, as well as other members from across Toronto, participated in the town hall. Members of CARP, the Canadian Association of Retired Persons, were also on the panel. It was an emotional meeting. I clearly remember one of my constituents, who was non-verbal and had to use her communication board, telling me that she wanted advance directives while she was lucid but could not predict whether she would be lucid in the foreseeable future.

In 2019, I had to do another presentation at a church in another riding. Here, overwhelmingly the audience was against the phrase “foreseeable future” and also wanted advance directives.

I am glad to see that some of the changes requested through consultations have now been incorporated. I look forward to the five-year review that is scheduled for June 2020 to see the discussions around advance directives.

I will now go to the bill itself and some of the changes it proposes to the eligibility criteria.

With regard to the proposed Criminal Code amendments in relation to eligibility, the bill proposes to make two changes to the current set of eligibility criteria for MAID. First, it would repeal the reasonable foreseeability of natural death criteria from the list of eligibility criteria in response to the Truchon ruling. That is good news for some of my constituents in Don Valley East. The legal effect of this amendment would be that those whose natural death is reasonably foreseeable and those whose natural death is not reasonably foreseeable would be eligible for MAID if they met all other eligible criteria.

Second, the bill proposes to exclude people whose sole underlying medical condition is mental illness. Many practitioners, stakeholders and experts have identified increased complexities regarding individuals seeking MAID whose sole underlying condition is mental illness. I suggest that this could be an item for Parliament to look at it in its upcoming mandatory five-year review of the MAID regime.

The Council of Canadian Academies' experts group issued a report in 2018 on the same issue and could not come to a consensus on this question. The Government of Quebec has also announced that access to MAID for cases where mental illness is the sole underlying condition would be suspended and that a broad consultation process would be conducted on this issue.

Regarding safeguards, the public needs to know some of the safeguards that will protect the vulnerable. With respect to the applicable safeguards proposed, the proposed Criminal Code amendment would create two different sets of safeguards depending on whether a person's natural death is expected in the near term or not. The first set of safeguards would continue to be tailored to persons who have a reasonably foreseeable death where risks are reduced. The second set of safeguards would be tailored to persons whose death is not reasonably foreseeable and would address the elevated risks associated with the diverse sources of suffering and vulnerability that could lead a person who is not nearing death to seek access to MAID, such as loneliness, isolation, lack of adequate supports and hopelessness.

Bill C-7 proposes to use the reasonable foreseeability of natural death standard to determine which set of safeguards applies to a particular case. This standard would also determine whether a person who is assessed and approved for MAID but who risks dying before the day of the procedure can give consent in advance. I will be discussing that proposal shortly.

How will these safeguards be applied? Specifically, it would require that a MAID request be witnessed by one independent witness instead of two, and it would allow individuals who are paid to provide either health or personal care to act as an independent witness.

On the advance consent or directives, the bill proposes amendments that would allow people who have a reasonably foreseeable natural death, and who have been assessed and approved for MAID, to retain their ability to receive MAID if they lose the capacity to consent.

The bill represents a significant paradigm shift in Canada's legal landscape with regard to medical assistance in dying. I call on members to support this important legislation and send it to committee for further review.